29 The impact of teicoplanin in prevention of implantable cardiac electrical devices infection. A single centre quality improvement audit

Background Infection of implantable cardiac electrical devices (ICEDs) is associated with increased morbidity and mortality. The rates are higher with devices’ replacement than with primary device implantation. Aims and objectives The aim of this project was to identify the rates of ICEDs and develop and implement strategies to reduce ICEDs infection in our centre in compliance with best practice. Methods This is a complete audit cycle completed in a cardiac tertiary centre to assess the impact of change from cefuroxime 1.5 g to Teicoplanin 10 mg/kg as our prophylactic antibiotic for device implantation. A total of 314 patients were involved. The first part of audit from 28/04/2016 to 07/3/2017 and re-auditing was from 1/8/2017 to 31/3/2018. The main devices reviewed were primary Cardiac Re-synchronization therapy devices (CRTs), primary implantable cardiac defibrillators/permanent pacemakers (ICD/PPM), and All CRTs, PPM, and ICD generators changes. We also reviewed Implantable loop recorders for best practice even though no prophylactic anti-biotics were required for their implantation. Results First part of the audit.208 devices were implanted during this period. There were 9 (4.4%) infected ICEDs and had to be explanted. Only 4 of 9 (44.4%) had positive blood cultures. Figure 1 summarises the most likely risk factors. InterventionPre-procedure antibiotics, cefuroxime 1.5 mg given less an hour prior to device implantation was changed to Teicoplanin 10 mg/kg rounded to the nearest 200 mg. Re-audit108 devices were implanted. The rate of ICED infections had decreased from 4.4% to 0% (p≤0.05) by 31st March 2018. Figures 2a and 2b compares all the ICED implanted during the audit cycle. Figure 3 illustrates the results post prophylactic anti-biotic change. Discussion and conclusion Continuous audit for quality improvement is beneficial, important and should always be encouraged. Teicoplanin is better than Cefuroxime as a prophylactic antibiotic in prevention of cardiac implantable electrical devices.